MRI of the prostate, combined with a blood test, can help determine if a prostate lesion is clinically significant cancer, new research suggests
A new meta-analysis by investigators from Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system, suggests that doctors and patients can avoid unnecessary prostate biopsies by combining MRI of the prostate findings with prostate-specific antigen (PSA) density. This new approach to diagnosing clinically significant prostate cancer can decrease patient harm and health care costs of prostate biopsies. Their results are published March 29 in JAMA Network Open.
An enlarged prostate or potential prostate cancer is a common issue for older men. There will be approximately 300,000 new cases of prostate cancer in the U.S. this year. But not all those cancers require treatment — or even need to be biopsied.
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"In the workup of men suspected of having prostate cancer, prostate MRI findings combined with PSA density measurement can help doctors decide which patients to biopsy," said senior author Ramin Khorasani, MD, MPH, Radiology Vice Chair for Quality and Safety at Brigham and Women’s Hospital and Mass General Brigham and Philip H. Cook Professor of Radiology at Harvard Medical School. "With this new analysis, we looked to see how MRI can help urologists decide which patients to biopsy and which patients may not need aggressive diagnosis and treatment."
Researchers have known for a long time that not all prostate cancer is dangerous. However, telling which cancers need treatment without a biopsy can be difficult. Biopsies, especially those of the prostate, can be uncomfortable, invasive, and expensive.
To doctors, clinically significant prostate cancer (csPCa) is prostate cancer that has a high chance of threatening a patient's life. They have cells that look more aggressive, or cancer is found outside of the prostate gland.
“Prostate cancer is the second most common cancer in men worldwide, but we need to be able to identify patients who require prostate biopsy while avoiding unnecessary procedures and minimizing the risk of missing clinically significant prostate cancer,” Adam Kibel, MD, chair of the Department of Urology and co-author of the study. “These findings suggest that patient-tailored prostate biopsy decisions based on information from MRI and blood tests could prevent unnecessary procedures while maintaining high sensitivity.”
